Exploring risk factors of pelvic organ prolapse at eastern of Democratic Republic of Congo: a case-control study

BACKGROUND

Pelvic organ prolapse is a common debilitating condition worldwide. Despite surgical treatment, its recurrence can reach up to 30%. It has multiple risk factors, some of which are particular for a low-resource settings. The identification these factors would help to devise risk models allowing the development of prevention policies. The objective of this study was to explore risk factors for pelvic organ prolapse in a population in eastern Democratic Republic of Congo (DRC).

METHODS

This was an unmatched case-control study conducted between January 2021 and January 2022. The sample size was estimated to be a total of 434 women (217 with prolapse as cases and 217 without prolapse as controls). Data comparisons were made using the Chi-Square and Student T tests. Binary and multivariate logistic regressions were used to determine associated factors. A p < 0.05 was considered significant.

RESULTS

Variables identified as definitive predictors of pelvic organ prolapse included low BMI (aOR 2.991; CI 1.419-6.307; p = 0.004), home birth (aOR 6.102; CI 3.526-10.561; p < 0.001), family history of POP (aOR 2.085; CI 1.107-3.924; p = 0.023), history of birth without an episiotomy (aOR 3.504; CI 2.031-6.048; p = 0), height ≤ 150 cm (aOR 5.328; CI 2.942-9.648; p < 0.001) and history of giving birth to a macrosomic baby (aOR 1.929; IC 1.121-3.321; p = 0.018).

CONCLUSIONS

This study identified that Body Mass Index and birth-related factors are definitive predictors of pelvic organ prolapse in a low-resource setting. These factors are potentially modifiable and should be targeted in any future pelvic organ prolapse prevention policy. Additionally, there seems to be a genetic predisposition for prolapse, which warrants further assessment in specifically designed large scale studies.

[Spontaneous open book uterine rupture at 15 weeks' gestation in a pauciparous woman with scarred uterus: a case study]

Despite all the health policies implemented in our developing countries, uterine rupture (RU) remains common. They are severe and involve maternal and fetal prognosis. Among the multiple risk factors, the most common cited in the literature is C-section scar. Most occurs during labor or at the end of pregnancy. Uterine rupture during the first or second trimester is exceptional and its clinical manifestation is variable. We here report a case of spontaneous uterine rupture at 15 weeks' gestation in a pauciparous woman with scarred uterus. Exacerbation of clinical symptoms was manifested by peritoneal irritation. Surgical exploration revealed complete vertical rupture from the bottom to the lower segment of the uterus with open book opening of the uterus. This study highlights that uterine rupture should be considered in patients with scarred uterus presenting with abdominal pain associated with signs of hemoperitoneum, regardless of whether their pregnancies are at term or in the first two trimesters, and regardless of age (young patients) and parity.